Wednesday, March 07, 2007

Back on the roller coaster...

It's been an odd couple of days. Luckily, energies are running high so they've just been odd... :)

Monday afternoon Brendan saw the orthodontist. It's been one year since his initial evaluation, where we learned that he would definitely need braces to correct an upper overbite & lower jaw arch problems. Fortunately, no surgery will be required, just 2 years (give or take) of braces. Even more fortunately, Brendan's pediatric dentist was able to send us to an orthodontist who has experience with autistic kids, & it really shows. At our first visit, last year, Brendan was hyper-chatty & into pretty much everything. The response of everyone who dealt with him was to be charmed by his obvious intelligence & interest in the proceedings. The orthodontist spoke directly to him when it came time to tell us the results of the exam, & the whole place is really relaxed & quiet. When we explained Brendan's oral-motor issues & voiced our concerns about loose appliances we were assured that they could do the work without his ever having to wear a removable device. Very good news. Since Brendan's 12-year molars hadn't fully erupted yet they couldn't begin the treatment last year, so they told us to come back this March. The thought of Brendan being done with braces before he even enters high school is very exciting to us parental units :)

Brendan was psyched to go back to the orthodontist this past Monday. He really liked the people there & remembered the doctor's name :) He was just as hyper & chatty & they were just as relaxed about it. After the exam we were told that Brendan was ready for braces. Whoo hoo! :) (Later in the day I asked him why he's so excited about getting braces & he said that it "was something new" & that it "would be a challenge"...) While we were there we consulted the doctor about Brendan's reporting another loose tooth, even though we'd thought he was finished with losing teeth. I was very nervous because Brendan is extremely aggressive with loose teeth & I could envision him working away at a permanent tooth... It turned out that this was, indeed, his last primary tooth to come out (we'd miscounted) & Brendan was told that it could take up to 2 months to come out, at it's present stage of looseness. This guy doesn't know Brendan, though... The good news was that it won't affect the schedule of getting braces. So, we got the list of suggested payment options (of course ) & I made 3 more appointments while they took Brendan upstairs for xrays & impressions of his teeth. He bounced off after the technician chatting away. I was a bit worried about the impressions bit, since I've had this done & it can be unpleasant (I felt like the goop was going to run down my throat) but Brendan came bouncing back about 20 minutes later, all excited about the possible uses (other than dentistry) for the alginate (the goop's real name...). He's thinking that encasing fleeing miscreants in the stuff would be the "havaheart" trap version of catching criminals.

We're all going back (dad, too) next Wednesday for the pre-treatment meeting, & they'll also insert spacers to get him ready for the bands. They will also repeat the do's & don'ts & explain how he'll have to clean & floss (he already flosses) with the braces on. The biggest issue I can see is that gum will be forbidden. (When I told Cherie, his consultant teacher, about this yesterday morning she kind of gasped.) Brendan gets significant deep pressure feedback from chewing gum, plus it seems to prevent him from putting other, less appropriate, things in his mouth. Sigh. He had been using a chewy tube a couple of years ago while watching tv at home (never at school) but then stopped abruptly & I never really found out why. I brought it up a few weeks ago, when I found him chewing on a lego, but he said he wouldn't use it. I brought it up again yesterday afternoon, since the gum ban is starting to sink in, & he was more interested in the idea of a chewy tube then. So I looked at them on the Integrations site & found a couple different kinds that Brendan thought he'd like to try. One kind acts as a kind of pencil-topper, which I thought would go over better at school, & it even has little terry-cloth covers to catch saliva & give a different sensory experience (Brendan liked the idea). He'd also been telling me how it would be cool if they were flavoured, but the closest I found was scented ones (chocolate & the like) so he said he'd try them, too.

The other impetus for getting chewies back in our lives was the end of Brendan's schoolday yesterday... He had called me around 1:00 all excited because he'd lost the loose tooth (remember? The one that was supposed to take 2 months to fall out...?). When I got there I was surprised to see that he was sitting away from the rest of the class (around the corner but still within earshot), who were having music & seemed upset. His music teacher came over & explained that Brendan had been asked to remove himself from class for spitting on another kid. I was rather taken aback because Brendan has never had much trouble with spitting before. Brendan was really upset with himself & just this side of meltdown, so my priority was to get him home & then try to sort things out. His teacher said that things were ok, he understood that Brendan hadn't meant to disrupt things, but Brendan was not able to forgive himself for his lack of judgement. (The teacher has since asked to meet with me tomorrow afternoon, which was kind of funny because I had told Cherie just this morning that we need to sit down with him & explain more in depth what's going on with Brendan...) I barely got Brendan out of the building without a meltdown, he was so upset. He didn't calm down at all in the car & was on the kitchen floor in meltdown mode when his nose brushed my sleeve & we both made a run for the tissues, since he'd snotted my sweater & his face has gotten smeared. Before we knew it we were laughing uproariously at this & he was fine. Once he was in a better place I decided to try to sort things out piece by piece, so I first asked him why he was spitting... I guess there were a couple of issues, one being that he had a paperclip in his mouth (!) & had to spit it out. Another was there was a bad taste in his mouth (from the paperclip perhaps?), & then finally it became a tic & he felt he had to spit. I explained to Brendan why people freak out when "spit happens" (spread of disease) & explained that, if he feels the need to spit, he should excuse himself & find a sink. I asked him to imagine spit=sink, so that it would become an automatic reaction over time. Brendan told me that he thought the kid who'd accidentally gotten the spit-out paper clip on his shoe was over-reacting & when I checked this out with Cherie this morning she agreed that this was a good possibility. Then we tackled the paper clip in his mouth... I asked him to imagine getting a paper clip stuck in his braces. He made a face & decided that it would be bad, & then I told him I'd find him some chewy things to use instead of paper clips & the like. The last thing I tried to address was his over-reaction to the whole thing. We talked about how embarrassing it can be to be called out of class, & also that we know that he's not going to remember appropriate behaviour all the time, but that he needs to cut himself some slack & allow himself room to make mistakes & learn from them.

Last evening, when Charlie & I talked about it all, we decided that his lapse in good judgement & over-reaction was very likely due to the decreased dose of seroquel. Sigh. We've seen small signs over the past couple of days that he's just not coping very well with life. Episodes of screaming because the tics won't let him alone (literally) & his not being able to do things like lego because it's not diverting enough & the OCD starts freaking him out. So we decided to resume the 50 mg twice daily (we had reduced his evening dose to 25 mg 2 weeks ago). It looks as though he's just going to have to outgrow the seroquel. From what we've been told, as Brendan grows & matures, he'll be able to take more cognitive control of the OCD (& he already has), plus the Tourettes may back-off as well. The main thing is that he have "a life" & not spend large amounts of time terrified or paralysed because of the OCD & be able to do the things he likes & wants to do.

Charlie usually takes Brendan to school on Wednesday mornings & either goes to work (just for the morning) or does errands & comes home. Today I accompanied them so that I could get Cherie up to speed on yesterday's music class doings... She was surprised & distressed when I told her what had happened, because they (the teachers) had been meeting right across the hall, & Brendan's classroom teacher, Jen, kept going out to see if everything was going ok. It all must have occurred right at the end of class. I told Cherie how we'd decided to handle the spitting & all about the chewy tubes, & she told me that one of Brendan's school friends had just started using a chewy tube at school, which was a great relief. I also mentioned that we're going to have to do more with deep pressure, & we both realised that we're having trouble getting him to accept it when he's really upset. I had used it to stave-off a meltdown over the weekend, when Brendan was just starting to get agitated, & Cherie had had a similar experience last week in gym class, but he won't let us do it when he's in meltdown mode. I mentioned that I'm thinking of making him a "shoulder pal" - a weighted object that he coulld wear over his shoulders at school to give him more consistent sensory feedback. I mentioned it to Brendan (I had seen one in the OT catalogue) & we talked about making it look like one of his pokemon, then he could wear it & have it be kind of fun. He said he might wear something like that at school... Cherie & I brainstormed some, too- she said that if there was a beanbag component (like the head or the tail) he might like it because she's seen him play with beanbags. I was thinking that making it out of fleece might make it fun to touch & pet, too. The main thing is to make him want to wear it... I will definitely have him help me sew it when the time comes. He's been bugging me to do another sewing project, so I'll bet knowing he's made the shoulder thingy himself will make him want to wear it :) Stay tuned...

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